Provider Demographics
NPI:1073630810
Name:DOBSON, MATTHEW LYNN
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LYNN
Last Name:DOBSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 33RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2829
Mailing Address - Country:US
Mailing Address - Phone:515-279-1857
Mailing Address - Fax:
Practice Address - Street 1:1609 33RD ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-2829
Practice Address - Country:US
Practice Address - Phone:515-279-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0431254Medicaid